tbuckley/cabot-search huggingface dataset:
Outcomes of a quality improvement project aimed at improving delivery of new anticancer drug education to nursing in an academic-community hybrid model.
Authors: Gayle C. Blouin, Crystal Derosier, Yun Man, Amy Morris, Daniel Aaron Roberts
Journal: Journal of Clinical Oncology (2022)

50 Background: Educating staff on new anticancer medications is imperative for patient safety. Infusion nurses at Dana Farber Cancer Institute (DFCI) satellite infusion centers were surveyed on their comfort level administering newer oncology drugs. Results revealed only 57% of nurses were “extremely comfortable or somewhat comfortable,” while 32% of nurses were “somewhat uncomfortable or very uncomfortable.” This project aimed to increase percentage of nurses at the satellites indicating they are “extremely comfortable” or “somewhat comfortable” from baseline of 57% to ≥75%. Methods: An interdisciplinary team including pharmacy, medical oncology, and nursing was formed to analyze workflows around new drug onboarding, staff education, and satellite communication. The team utilized Plan-Do-Study-Act (PDSA) cycle methodology. Tools included process maps and fishbone to identify areas of improvement. Intervention development tools included a Pareto chart and a priority matrix. Results were analyzed using statistical process control charts. Results: PDSA cycle 1 consisted of making the pharmacy driven education sheet, At-A-Glance (AAG), more accessible for new drugs. AAGs for drugs approved by the FDA in the previous 18 months were posted on the DFCI pharmacy intranet page. Nurses were educated on how to access AAG weekly. For PDSA cycle 2, the survey was modified to target individual nurses administering new drugs rather than all nurses. A “Nursing consideration” section was added to the AAG template and workflow developed; Navigation and review of AAG was added to nursing competency. Monthly nursing/pharmacy huddles were established to optimize communication. These interventions increased the percentage of nurses indicating they are “extremely comfortable” or “somewhat comfortable” to ≥75% which was sustainable through PDSA cycle 2 (see Table). Conclusions: Making an easy-to-use nursing education resource accessible improved nursing comfort level. There were challenges with nursing survey due to COVID-19 surge and staff shortages. Routine huddles are essential for sustainability.[Table: see text]
Spreading routine serious illness conversations at a single cancer center using a multidisciplinary and patient-family advisory approach.
Authors: Garrett Thomas Wasp, Karen Guo, Matthew Wilson, Maxwell Thomas Vergo, Andy Willaims, James J. Perry, Megan M. Holthoff, Madge E. Buus-Frank, Amelia M. Cullinan
Journal: Journal of Clinical Oncology (2022)

367 Background: ASCO Guidelines recommend oncologists conduct serious illness conservations (SIC) for all patients with advanced cancer. We describe the spreading of a multidisciplinary and patient-family advisor (PFA) quality improvement (QI) initiative to conduct routine SIC at a NCI-designated comprehensive cancer center. Methods: This single center study describes the second phase of a learning health system initiative to conduct routine SIC for all seriously ill patients with cancer. Prior work completed included defining patient eligibility (e.g. two-year surprise question), and deploying a SIC template in the electronic health record (EHR) to capture SIC in a centralized location. Phase II can be categorized into three steps: a) increasing communication coach and PFA capacity; b) refining EHR tools to automate tracking and reporting of outcomes; and c) adoption of the Model for Improvement as the QI methodology to guide testing and implementation. For the first three months, each team engaged in preparatory work including: process mapping, key driver diagram development, and SIC Guide training. In the last six months, each team met weekly to set their own team goals, conducted iterative PDSAs, and reviewed run charts of their performance. Patient-level data on SIC documentation was collected through automated EHR tools and provided to the teams on a weekly basis. Results: Over nine months (3/1/2021 to 12/31/21), four teams screened 510 patients with cancer, identified 272 (53%) patients as eligible for SIC, and 178 (65%) of those eligible had a documented SIC from a baseline of 0%. The breakdown of this combined SIC patient count by clinician author is as follows: team A 40 (22%); team B 45 (25%); team C 9 (5%); team D 14 (8%) and specialty palliative care 70 (39%). Each team set modest, initial SIC documentation goals (range 5-15%), and attainment of first SIC documentation goal varied (range 2 to 4 months). We retained all clinician team members during the study period, but 2 out of 3 PFAs left by study period end. Noted challenges with PFA recruitment and retention included: lengthy recruitment, integration into clinical teams, and resistance to change by teams. Conclusions: The multidisciplinary approach, inclusive of specialty palliative care, increased SIC documentation. PFA involvement, as implemented, met with challenges and yielded mixed results. Additional follow-up will be required to assess if gains can be sustained and/or increased.
Financial toxicity of front-line platinum etoposide plus atezolizumab versus durvalumab in extensive-stage small-cell (ES-SCLC) lung cancer.
Authors: Bradley Harrison, Nicole Keith, Allison Verbyla, Kathryn Finch Mileham
Journal: Journal of Clinical Oncology (2022)

23 Background: With the continued advent of new therapeutics, burgeoning costs and financial toxicity are more frequently a complication in comprehensive cancer care. At Levine Cancer Institute (LCI), a multidisciplinary Financial Toxicity Tumor Board has driven $55-60 million in cost savings for patients annually, and presented patient cases can serve as a continual impetus for iterative quality improvement and cost-savings research. One such example highlights the augmented risk of financial toxicity resultant from increasing utilization of front-line chemoimmunotherapy (chemo-IO) in ES-SCLC. Both atezolizumab and durvalumab in concert with platinum-etoposide chemotherapy separately portend an overall survival benefit. Retrospective analyses have failed to demonstrate a PFS or OS advantage between the two regimens. Amidst comparable efficacy, we sought to ascertain institutional variance in cost profiles and financial toxicity. Methods: Billing and demographic data for patients with ES-SCLC who received chemo-IO with durvalumab or atezolizumab in an LCI hospital-based outpatient infusion center were queried. Treatment dates encompassed October 1, 2019 through April 30, 2022. Patient costs were compared and exploratory analyses were performed related to patient demographics, patient geography (with financial characteristics per Census data) and bad debt proportions. Results: 211 patients received chemo-IO with atezolizumab, and 108 patients received chemo-IO with durvalumab. Medicare (+/- supplementary insurance), Medicare Advantage, and commercial insurance constituted 85% of payors. Institutional covenants restrict publication of commercial and supplementary insurance data; for compliance and generalizability, reported is the Medicare-only population. Medicare allowables of $6791 and $8429 were utilized per dose of atezolizumab 1200 mg and durvalumab 1500 mg, respectively. Amidst 20% patient responsibility with Medicare, durvalumab patient cost was $327.60 higher per cycle. Incorporating observed mean number of cycles of 5.20 for atezolizumab and 5.31 for durvalumab, an average course of durvalumab was $1836.56 more expensive. Assessing the entire population, 24% of patients in both groups met criteria for bad debt; however, mean quantity of bad debt was 62% higher with durvalumab ($8988.77) than with atezolizumab ($5555.11). Bad debt was disproportionately congregated in lower income zip codes (data to be displayed pictorally). Conclusions: Chemo-IO with durvalumab was $1834.56 more expensive per treatment course in ES-SCLC, with 62% increase in quantity of bad debt relative to atezolizumab. Future directions may focus on institutional interventions to mitigate financial toxicity related to therapy choice and geographic allocation of resources, as well as the assessment of cost variance in other solid tumors.
Promoting prostate cancer screening equity: Findings from a quality improvement education initiative implemented in 3 sites.
Authors: Ginny Jacobs, Kristen Stevens Hobbs, Keith Crawford, Waseem Hussain, Claire Jean-Simon, Roxanne Leiba Lawrence, Patrice Lazure, Laura Lee Hall, Pam McFadden
Journal: Journal of Clinical Oncology (2022)

112 Background: Prostate cancer (PC) screening guidelines differ in recommended age at screening and varying emphasis on risk factors (e.g., race, family history), leading to lack of clarity among healthcare providers (HCPs). Research has highlighted a higher risk for Black patients, and the importance for at-risk patients to undergo screening at an earlier age and receive appropriate follow-up. A system-based Quality Improvement Education (QIE) intervention was developed to increase screening and referrals for PC especially among higher risk subgroups. The QIE aimed to increase awareness of the burden and consequences of racial disparities while mobilizing a team-focused approach. Methods: QIE intervention was deployed at 3 practice sites that provide community-based primary care services to Black populations (72% Black patients). The sites differed in patient capacity, staff, challenges faced, and pre-intervention screening practices. Practice assessments were completed pre-intervention by site representatives (n = 3) and individual baseline surveys were filled out by HCPs (n = 24). The 12-week intervention included educational materials from Prostate Health Education Network (PHEN) and deployment of an updated screening protocol within each clinic to raise PC awareness to staff and patients. Post-intervention evaluation was based on qualitative interviews (n = 5) and feedback from the QIE coaches. Patient data from electronic health records (EHR) on PC screening and referrals was collected post-initiative and divided a posteriori into 3 sub-groups, pre, during and post-intervention (n = 6662). Results: QIE led to increased awareness of barriers to access faced by patients from diverse communities. The QIE also led to increased awareness among team members regarding the need for screening at-risk groups at an earlier age and the importance of follow-up with patients. Online education materials made available to HCPs raised patient awareness. Table highlights an increase in PC screening during the intervention, but limited sustainability post-intervention. Interviewees reported increases in patient education, referrals and follow-up action. Conclusions: Increase in percentage of patients screened during the intervention phase was potentially due to added attention during the initiative, while limited sustainability post-intervention might be due to the brief intervention period, reliance on retrospective data and inability to fully leverage EHR data. Based on this projects learnings, similar initiatives should seek organizational support for data analytics and process documentation to ensure consistent data standards and overall success.[Table: see text]
Overall survival by race and ethnicity among men with metastatic castration-resistant prostate cancer (mCRPC) in the U.S. Medicare population.
Authors: Stephen J. Freedland, Matthew Davis, Andrew J. Epstein, Bhakti Arondekar, Jasmina I. Ivanova
Journal: Journal of Clinical Oncology (2022)

144 Background: Previous studies reported mixed findings about racial and ethnic disparities in overall survival (OS) in mCRPC. This study describes OS by race and ethnicity among men with mCRPC in the US Medicare population. Methods: Men newly diagnosed with mCRPC were identified in Medicare fee-for-service claims during 1/1/2014–6/30/2019. Adult men were required to have a diagnosis of prostate cancer, metastasis diagnosis, castration-resistance using a published claims-based algorithm, and continuous insurance coverage for ≥1 year before and ≥6 months after index mCRPC diagnosis unless patients died. OS from mCRPC diagnosis and from start of first-line (1L) therapy for mCRPC for White (W), Black (B), Hispanic (H), and Asian (A) men were estimated using Kaplan-Meier analysis and Cox proportional hazards models adjusting for patient characteristics and 1L mCRPC therapy type or no treatment. Results: Among 14,780 men with mCRPC in this study, 75% were W, 14% were B, 6% were H, 3% were A, and 3% were of other or unknown race. Mean age at mCRPC diagnosis was 76 years among W men; B men had similar age while H and A men were slightly older than W men (Table). B, H, and A men had higher Quan-Charlson Comorbidity Index (CCI) than W men. Median follow-up after mCRPC diagnosis was 17 months. Similar proportions of W, H and A men (78%, 78%, and 79%, respectively) and lower proportion of B men (75%) initiated 1L life-prolonging therapy after mCRPC diagnosis. Among treated men, higher proportions of B, H, and A men (71%, 74%, and 73%, respectively) initiated 1L therapy with novel hormonal therapy than W men (64%). Median OS after mCRPC diagnosis was 26.0, 22.3, 22.9, and 24.2 months among W, B, H, and A men, respectively. Median OS after initiation of 1L mCRPC therapy was 23.8, 21.1, 19.9, and 24.1 months among W, B, H, and A men, respectively. After adjusting for patient characteristics and 1L treatment, OS was not different for B and H men relative to W men, while A men had lower risk of death. (Table). Conclusions: This study found no statistically significant differences in overall survival in mCRPC for B and H men and lower risk of death for A men relative to W men after adjusting for patient characteristics and treatment in the US Medicare population.[Table: see text]
Multiscale modeling intervention development and perspectives from early-stage breast cancer survivors on technology to improve long-term adherence to endocrine therapy.
Authors: Manuel Gonzales, Cristian Garcia-Alcaraz, Navreet Kaur, Jiaqi Gong, Xishi Zhu, Sarah Tolman, Laura E Barnes, Kristen J Wells
Journal: Journal of Clinical Oncology (2022)

442 Background: Despite the important role of endocrine therapy (ET) in preventing cancer recurrence, rates of long-term adherence are poor among certain breast cancer survivors (BCS). Traditional medication adherence (MA) interventions that have primarily incorporated medication-taking reminders mainly focused on a “one size fits all” approach, which may explain why many interventions have proven unsuccessful. However, when combined with other context, sensors (i.e., wearable sensors, smartphone sensors) can facilitate a better understanding of medication-taking behaviors leading to individualized interventions that are time and context appropriate. The project team is developing a multiscale modeling and intervention (MMI) system designed to improve adherence to ET among BCS. This study describes MMI development. Methods: MMI development has included: 1) usability testing; 2) review of research literature regarding factors associated with ET MA; and 3) a neural network analysis of previously collected ET MA data. In usability testing, 20 BCS were recruited via social media posts to participate in semi-structured usability interviews. Interviews were conducted via videoconferencing and assessed perceptions of and willingness to use an ecological momentary assessment (EMA) smartphone app, smartwatch, smart pill bottle, and smart pill box. The literature review examined multiple systematic reviews to identify constructs associated with ET MA. Randomized neural network analysis with 32 early stage BCS taking ET was used to determine important features of ET MA 4 weeks following completion of a 346-item survey. Four-week medication adherence was measured daily with a medication event monitoring system (MEMS). Results: Usability testing participants were accepting of each technology and willing to use each technology at various frequencies. Forty-two surveys were reviewed as predictors of MA in systematic reviews. Randomized neural network analysis found 104 survey items had absolute weights at the 70 th percentile, indicating a strong influence on week 4 ET MA, and 11 surveys were determined theoretically relevant. Conclusions: BCS are willing to use 4 components of the MMI system. The MMI system will soon be deployed for 6 months of data collection. If shown to be effective, the MMI framework can be used by oncologists and researchers to develop personalized interventions focused on understanding and increasing ET MA.
Effects of establishing a multidisciplinary pancreatic cancer clinic on time-to-treatment.
Authors: Raj Vaghjiani, Joy Sarkar, Zachary Stiles, Jennifer Pangelinan, Renuka V. Iyer, Benjamin F. Calvo, Moshim Kukar, Steven N. Hochwald, Nadia Karen Malik, Christos Fountzilas, Sylvia Vania Alarcon Velasco, Leonid Cherkassky
Journal: Journal of Clinical Oncology (2022)

61 Background: Despite recent advances, pancreatic cancer remains an exceedingly morbid disease. This is often attributed to the lack of effective screening tools and the consequent late presentation of patients. The best prognosis is reserved for patients with resectable tumors thus highlighting the importance of swift evaluation and the initiation of treatment following a diagnosis. Multidisciplinary clinics allow for the expedient evaluation of patients by different subspecialties in the same day. Methods: A newly designed, multidisciplinary workflow (MDC-multidisciplinary care clinic) for patients recently diagnosed with pancreatic adenocarcinoma was established at a single, tertiary-care comprehensive cancer center in September of 2021. Patients presenting to MDC undergo same day consultation by surgical oncology, medical oncology, receive genetics counseling and testing, nutrition counseling, and additional support services as indicated. Patients from a prospectively maintained database were compared from before (n = 14) and after (n = 30) implementation of the new workflow. Average time to provider consultation, port placement, and initiation of neoadjuvant chemotherapy were compared using student’s t-test. Results: After a biopsy diagnosis of pancreatic adenocarcinoma, the time interval from initial surgical consultation to initial medical oncology consultation improved from 7d to 1d ( p=.003) with the implementation of MDC. Over 90% of patients were seen on the same day after the MDC was established, compared to just 7% before. There was no difference in the time from initial biopsy diagnosis to initial surgical consultation, biopsy to initial medical oncology consultation, biopsy to port placement, or biopsy to chemotherapy initiation. Conclusions: In this early experience with a new pancreatic cancer multidisciplinary clinic, patients experienced improvements in time to subspecialty evaluation by nearly 7 days. Additionally, prospective data on oncologic outcomes and patient quality-of-care metrics are ongoing; however, this quality improvement effort has already reduced patient burdens in accessing timely care. Our continued efforts focus on further improving care coordination along the entire patient cancer care trajectory.
Does the 4R oncology model improve clinicians’ effectiveness in patient-facing planning of complex cancer care?
Authors: Julia R. Trosman, Swati Kulkarni, Rachel Podrazik Baer, Lawrence Eric Feldman, Mary Pasquinelli, Sheetal Mehta Kircher, Al Bowen Benson, William John Gradishar, Bruce Rapkin, Della F. Makower, Claudia Beth Perez, Stephanie Boecher, Arliene Ravelo, Elaine Yu, Christine B. Weldon
Journal: Journal of Clinical Oncology (2022)

344 Background: The 4R Oncology model was proposed within the NCI ASCO Teams Project as an approach to facilitate patient facing care planning, team based delivery and patient self-management. 4R (Right Info/Care/Patient/Time) enables care teams and patients to manage complex care with a novel 4R Care Sequence plan. We previously reported that 4R significantly improved patient self-management, namely patients’ ability to organize and manage their care (Trosman JCO OP 2021). Here we report the impact of 4R on effectiveness of clinicians to plan and deliver complex multidisciplinary care. Methods: We surveyed clinicians (physicians and nurses) from 8 cancer centers (4 academic, 4 community) participating in a 4R adoption program. The survey was conducted Mar 2019 to Sep 2019 prior to 4R launch (Baseline cohort), and Nov 2021 to Jan 2022 post-4R launch (4R cohort). Baseline cohort included clinicians conducting care planning with patients. 4R cohort included clinicians who used 4R in care planning with patients. The survey focused on clinicians’ self-reported effectiveness in planning and management of guideline care. Descriptive statistics and Fisher’s 2-sided test were used in analyses. Results: Baseline cohort response rate was 79% (66/83); 4R cohort response rate was 86% (62/72). 4R implementation was associated with significant improvement in all 6 metrics of effective care planning between the baseline and 4R cohorts (Table). Within the 4R cohort, 87% (54/62) clinicians found 4R Care Sequences useful or very useful for care planning and management. The majority, 79% (49/62), spent ≤ 10 minutes on average developing and administering 4R Care Sequence to a new patient, and 58% (36/62) reported decreased overall volume of post-visit inquiries about care plan from patients who received 4R. When asked about 4R delivery format, 65% (40/62) preferred paper, 23% (14/62) electronic delivery and 12% (8/62) had no preference. Conclusions: The 4R Oncology model is a promising approach to improving clinicians’ effectiveness in patient facing care planning and reducing the workload associated with patient inquiries. An ongoing 4R research and implementation program continues efforts to identify optimal implementation methods and integrate 4R into clinical practice across the U.S.[Table: see text]